Insurance Claims Manager (State Risk Adjuster 6)
Company: State of Louisiana
Location: Baton Rouge
Posted on: September 15, 2023
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Job Description:
Salary : $4,470.00 - $8,767.00 Monthly
Location : Baton Rouge, LA
Job Type: Classified
Job Number: ORM 090823 ERG
Department: Division of Administration-Risk Management
Opening Date: 09/08/2023
Closing Date: 9/22/2023 11:59 PM Central
Supplemental Information
The Division of Administration/Office of Risk Management has a
vacancy. This job title has an assigned pay grade of AS-619.
This vacancy will be filled by new hire or by promotion of a
current permanent status classified employee.
A criminal history check may be conducted on all new hires as well
as employees changing positions including promotions, demotions,
details, reassignments and transfers. Also, prospective employees
may be subject to pre-employment drug testing. New hires will be
subject to employment eligibility verification via the federal
government's E-verify system.
No Civil Service test score is required in order to be considered
for this vacancy.
To apply for this vacancy, click on the "Apply" link above and
complete an electronic application which can be used for this
vacancy as well as future job opportunities. Applicants are
responsible for checking the status of their application to
determine where they are in the recruitment process. Further status
message information is located under the information section of the
Current Job Opportunities page.
Resumes WILL NOT be accepted in lieu of completed education and
experience sections on your application. Applications may be
rejected if incomplete.
Applicants qualifying based on college training or receipt of a
baccalaureate degree will be required to submit an official college
transcript to verify credentials claimed prior to appointment.
Please make every effort to attach a copy of your transcript to
your application. The transcripts can be added as an attachment to
your online application or faxed to (225) 219-1041. The selected
candidate will be required to submit original documentation upon
hire.
For further information about this posting, please contact:
Erica R. Gay
HR Specialist
Division of Administration/Office of Human Resources
email: erica.gay@la.gov
Qualifications
MINIMUM QUALIFICATIONS:
A baccalaureate degree plus four years of professional level
experience in insurance claims adjusting, nursing, allied heath
fields, construction management, or as a practicing attorney.
SUBSTITUTIONS:
A master's degree in business or public administration, finance,
accounting, statistics, insurance or risk management, safety or
legal studies, nursing, allied health fields, or construction
management will substitute for one year of the experience.
Experience in the fields of accident investigation, insurance
claims examining, insurance claims investigation or insurance
claims adjusting will substitute for the required college training
on the basis of 30 semester hours for one year of experience.
NOTE:
This substitution allows any combination of experience and college
hours to substitute for the baccalaureate degree. Thirty semester
hours of college training is accepted as equivalent to one year of
work experience, and college credit in increments of fewer than 30
hours is prorated on this basis.
NOTE:
Any college hours or degree must be from an accredited college or
university.
Job Concepts
Function of Work:
To manage one of three claims sections of the multi-line property
and casualty self-insurance program of the State.
Level of Work:
Manager.
Supervision Received:
Administrative direction from the State Risk Administrator
(Claims).
Supervision Exercised:
Direct line over State Risk Adjuster 5's.
Location of Work:
Division of Administration, Office of Risk Management.
Job Distinctions:
Differs from State Risk Adjuster 5 by responsibility for managing a
section of claims adjustment units rather than a single unit within
a section, and by a higher claim payment authority.
Differs from the State Risk Administrator (Underwriting and Loss
Prevention) by the absence of responsibility for the comprehensive
risk program.
Differs from the State Risk Administrator (Claims) by the absence
of full authority for the claims adjustment division, and by
unlimited claims payment authority and unlimited authority when
participating as a member of the Claims Council.
Examples of Work
The State Risk Adjuster 6 is a manager position, directly
supervising subordinate State Risk 5 Adjuster (Supervisors)
positions. Performs personnel supervision and administration. Uses
good communication, documentation, observation, and assessment
skills to fairly plan and accurately evaluate the performance of
each employee supervised. Develops professional growth and/or
improvement plans for unit personnel.
Responsible for program management, directing and consulting with
direct reports who are the first line supervisors to oversee,
monitor and review the work of the State's Third Party
Administrator's (TPA) desk examiners and claim adjusters in
responding to self-insured claims and insured commercial claims.
Supervisors ensure claims are efficiently handled in accordance
with the Risk Management Program's insurance policies; state laws
and regulations; administrative policies and rules; and ORM
procedures, guidelines, goals and directives. Develops and
maintains desk references with procedures and practices to be
followed by the Supervisors and client instructions that relate to
claim handling by the TPA staff.
The position has functional management over the TPA's claims
handling activities relating to General Liability coverage which
includes Premise Liability, Errors and Omissions, False Arrest,
Civil and Constitutional Rights, etc. The Manager serves as the
primary assistant to the State Risk Administrator for Casualty
Claims, in relation to all claim services, duties and
responsibilities associated with the assigned lines of insurance.
The position reports to and receives administrative direction from
the Administrator.
Reviews, responds to inquiries and manages problems relating to
coverage questions; reserves; catastrophic losses; investigations
of cause and extent of loss; and other claims related issues.
Investigates, troubleshoots, proposes solutions and leads in
resolution of serious problems impacting claims management. Reviews
catastrophic claim files with Supervisors and the Administrator to
develop strategies and offer suggestions and advice for further TPA
handling and claim management. Reviews and make decisions on
complex coverage issues. Maintains reports on high profile claims.
Responsible for ensuring that the TPA complies with contract terms.
Exercises contract management oversight, utilizing performance
standards and guidelines in evaluating claim files and conducting
performance reviews of the TPA and its employees.
Particular emphasis is placed on monitoring/auditing activities of
the TPA relative to payments in excess of $25,000 and reserves in
excess of $250,000. Maintains written claim monitoring and
performance management plans. Ensures that the TPA provides the
specified levels of service they are contracted to carry out and
represent the State of Louisiana's best interests in the work they
perform. Participates in meetings with TPA's executives and
high-ranking members of management, to present information and
discuss service challenges. Accountable for completeness and
accuracy of established reserves on claims. Reviews cases in excess
of $1,000,000 for financial impact and verification of involvement
with the State's excess carrier and to ensure the TPA seeks
recovery of expenditures over the State's retention level when
applicable.
Serves as a voting member of claims council along with the
Administrator and the Assistant Director for Litigation Management,
which authorizes trial authority and/or settlement authority, etc.
up to $5,000,000 contingent upon additional approval from the
Commissioner of Administration, the Attorney General, and the
Litigation Subcommittee of the Joint Legislative Committee on the
Budget when funding is $500,000 or above. Authorizes payments up to
$200,000 and authority to increase reserves up to $1,000,000
without additional approvals. Possesses direct authority on
subrogation files to waive up to 50% of the total recoverable lien
amount in exchange for a full and final release of the claim.
Performs the functions involved in costs and system analysis,
dissemination of information and budget and resource development
for the management of the business unit. Reviews proposed
legislation for fiscal impact on ORM as well as the State. Performs
any and all other duties as assigned.
Louisiana State Government represents a wide variety of career
options and offers an outstanding opportunity to make a difference
through public service. With an array of career opportunities in
every major metropolitan center and in many rural areas, state
employment provides an outstanding option to begin or continue your
career.
As a state employee, you will earn competitive pay, choose from a
variety of benefits, and have access to a great professional
development program:
Insurance Coverage More information can be found at
Holidays and Leave - State employees receive the following paid
holidays each year:
***** Additional holidays may be proclaimed by the Governor
State employees earn sick and annual leave which can be accumulated
and saved for future use. Your accrual rate increases as your years
of service increase.
Retirement- State of Louisiana employees are eligible to
participate in various retirement systems (based on the type of
appointment and agency for which an employee works). These
retirement systems provide retirement allowances and other benefits
for state officers and employees and their beneficiaries. State
retirement systems may include (but are not limited to):
01
Do you possess any managerial experience? If so, provide
information as to how many employees have you supervised and
explain to what degree?
02
How do you deal with conflict in the workplace?
03
Do you work well on a team? How would you define teamwork?
04
Do you have experience supervising and/or authorizing insurance
claims adjusting services provided by contract personnel employed
by a Third Party Administrator? If yes, provide details of your
role and responsibilities.
05
Do you have any experience reviewing and evaluating tort liability
insurance cases involving litigation? If yes, describe your overall
experience and specifically address tort liability litigation areas
relating to inmates/prisoners, ADA, and/or violation of civil
rights.
06
Describe prior experience overseeing litigation management,
including reviewing and authorizing tort liability litigation
defense budgets and/or requests for settlement authority.
07
Are you familiar with reservation of rights letters? If yes,
describe your experience in the preparation or processing of
such.
08
Describe any experience in reviewing lawsuits to evaluate for
insurance coverage, including defense and indemnification.
09
Describe your experience, training and skill level using Microsoft
Excel and Word.
Required Question
Keywords: State of Louisiana, Baton Rouge , Insurance Claims Manager (State Risk Adjuster 6), Executive , Baton Rouge, Louisiana
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